CCT Billing and Coding Compliance 3

Question 1

What is a chargemaster (charge description master) in a hospital setting?

Accepted Answer

A comprehensive listing of all services, procedures, and items a facility may bill for along with their standard charges

Answer

A chargemaster is the hospital's internal master price list containing every billable item and service with its associated standard charge, serving as the starting point for all billing.

Question 2

What is 'downcoding' in medical billing?

Accepted Answer

Billing for a lower level of service than was actually provided, often due to insufficient documentation

Answer

Downcoding occurs when a provider bills for a lower level of service than was actually provided, typically because the documentation does not adequately support the higher-level service.

Question 3

Which of the following best describes 'medical necessity' in the context of billing compliance?

Accepted Answer

Services that are reasonable and necessary for the diagnosis or treatment of illness or injury, meeting accepted standards of care

Answer

Medical necessity refers to services or supplies that are appropriate and needed for diagnosing or treating a medical condition, consistent with accepted standards of good medical practice and not primarily for the patient's convenience.

Question 4

What is a 'remittance advice' (RA) in medical billing?

Accepted Answer

A notice from a payer explaining how a claim was processed, including payment amounts or denial reasons

Answer

A remittance advice is issued by a payer to a provider after claim adjudication, detailing any payment made, contractual adjustments applied, patient responsibility amounts, and the reason codes for any denials.

Question 5

Why is the routine waiver of patient copayments considered a compliance risk?

Accepted Answer

It is fraudulent because it artificially inflates effective reimbursement and may induce overutilization, potentially violating anti-kickback statutes

Answer

Routinely waiving copayments is considered fraudulent because it removes a cost-sharing incentive, can induce patients to overuse services, and may constitute an illegal inducement under the Anti-Kickback Statute.

(CCT) Certified Compliance Technician Practice Test

(CCT) Certified Compliance Technician Practice Test

CCT Billing and Coding Compliance 3